title: Adverse events associated with mohs micrographic surgery: multicenter prospective cohort study of 20,821 cases at 23 centers.
abstract: OBJECTIVE
  Detailed information regarding perioperative risk and adverse events associated with Mohs micrographic surgery (MMS) can guide clinical management. Much of the data regarding complications of MMS are anecdotal or report findings from single centers or single events.
  
  
  OBJECTIVE
  To quantify adverse events associated with MMS and detect differences relevant to safety.
  
  
  METHODS
  Multicenter prospective inception cohort study of 21 private and 2 institutional US ambulatory referral centers for MMS. Participants were a consecutive sample of patients presenting with MMS for 35 weeks at each center, with staggered start times.
  
  
  METHODS
  Mohs micrographic surgery. MAIN OUTCOMES AND MEASURES Intraoperative and postoperative minor and serious adverse events.
  
  
  RESULTS
  Among 20 821 MMS procedures, 149 adverse events (0.72%), including 4 serious events (0.02%), and no deaths were reported. Common adverse events reported were infections (61.1%), dehiscence and partial or full necrosis (20.1%), and bleeding and hematoma (15.4%). Most bleeding and wound-healing complications occurred in patients receiving anticoagulation therapy. Use of some antiseptics and antibiotics and sterile gloves during MMS were associated with modest reduction of risk for adverse events.
  
  
  CONCLUSIONS
  Mohs micrographic surgery is safe, with a very low rate of adverse events, an exceedingly low rate of serious adverse events, and an undetectable mortality rate. Common complications include infections, followed by impaired wound healing and bleeding. Bleeding and wound-healing issues are often associated with preexisting anticoagulation therapy, which is nonetheless managed safely during MMS. We are not certain whether the small effects seen with the use of sterile gloves and antiseptics and antibiotics are clinically significant and whether wide-scale practice changes would be cost-effective given the small risk reductions.
authors.affiliation: Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois2Department of Otolaryngology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois3Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois4Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois.
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authors.affiliation: Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
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authors.affiliation: Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
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authors.affiliation: Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
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mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D000891:Anti-Infective Agents, Local / Q000008:administration & dosage; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D015331:Cohort Studies; D005260:Female; D005932:Gloves, Surgical; D006801:Humans; D008297:Male; D015580:Mohs Surgery / Q000009:adverse effects* / Q000379:methods; D011446:Prospective Studies; D012878:Skin Neoplasms / Q000601:surgery*; D013530:Surgical Wound Infection / Q000453:epidemiology* / Q000517:prevention & control; D014481:United States; D014945:Wound Healing / Q000502:physiology
chemical_list: D000900:Anti-Bacterial Agents; D000891:Anti-Infective Agents, Local; D000925:Anticoagulants